Apparatus and method for exercising and monitoring the performance of the upper flexor muscles of the neck

ABSTRACT

An apparatus that preferably takes the form of a collar for exercising or assessing the upper cervical flexor muscles to assist with headaches. The apparatus includes a resiliently compressible cushion that fits under the mandible of the user but not extending as far as the chin. The user bends their head against the cushion to achieve an elevated pressure and preferably maintains the pressure for a period of time. The absence of sensory feedback of pressure against the chin inhibits the drive to use muscles ofther than the upper cervical flexor muscles. The cushion may be an inflatable bladder so that the pressure against which the head works can be varied. The cushion preferably includes pressure measuring means to measure changes in pressure within the cushion to monitor the performance of the upper cervical flexor muscles.

[0001] The present invention relates to an apparatus and method for exercising and monitoring the performance of the upper flexor muscles of the neck.

BACKGROUND OF THE INVENTION

[0002] The upper cervical flexor group of muscles, comprising the longus colli and captis and rectus captis anterior and lateralis, are postural muscles located in the neck that have a predominantly stabilising role and provide a holding mechanism to maintain balance and stability for the head. The upper cervical flexors (UCFs) work to maintain the head in a posture whereby the chin is tucked in as opposed to a posture in which the head is positioned forward (known as forward head posture or poking chin posture).

[0003] There is a growing body of clinical evidence to suggest that in many cervicogenic (neck) headache sufferers, the UCFs have poor endurance and are unable to maintain a non forward head posture. In particular, a group of headache sufferers has been found to be statistically different to a control group of non-headache sufferers in respect of forward head posture (FHP) as well as isometric strength and endurance of the UCFs (Watson, D. H. and Trott, P. H., Cephalalgia 13 (1993), 272-282). This poor endurance is believed to be responsible at least in part for the symptomatic headaches suffered by these people. It will be appreciated that it is a lack of endurance of the UCFs that appears to be critical in causing headaches as opposed to any lack of strength in the UCFs.

[0004] Identification and rectification of poor endurance in the UCFs therefore may provide an opportunity for diagnosis and rectification of the symptoms of headaches suffered by many patients who suffer from cervicogenic headaches.

[0005] The UCFs may be exercised by performing upper cervical flexion which are a flexion of the head on the neck that involve an action that is akin to nodding ‘yes’. Upper cervical flexion is to be contrasted to flexion of the neck on the thorax or trunk (so called lower cervical or cervical flexion), which is a different movement that is controlled by a different set of muscles that are categorised as ‘prime movers’ and with which the emphasis is on strength.

[0006] In order to properly exercise and measure performance of the UCFs the head flexion movement needs to be very precise in order to isolate the UCFs from other neck muscles. Therefore any diagnostic identification of poor endurance UCFs and any exercise regime designed to increase the endurance of the UCFs needs to eliminate lower cervical or cervical flexion. Equipment to assess the performance of the UCF musculature has been previously developed by the present inventor. This equipment consisted of a plinth with a moveable head section. Subjects were positioned laying on their backs (supine) and performed head on neck flexion against the resistance provided by a metal bar which was attached to the plinth and whose deflection was detected using strain gauges. In this case the equipment is specialised and required attendance at a practitioners premises and is not suitable for general unattended use.

[0007] Jull et al. (Jull, G. et al., Cephalalgia 19 (1999), 179-185) have also described a apparatus for testing upper cervical flexion. The apparatus comprises an inflatable bladder upon which the patient lies such that the pouch is positioned behind the neck. The pouch contains a pressure sensor which monitors the flattening of the cervical lordosis which is the natural anterior convexity or posterior concavity of the spine at the neck. However use of this apparatus requires correct positioning of the apparatus on the neck and requires the patient to be laying on top of it in order to achieve the results.

[0008] None of the apparatuses available to date for monitoring upper cervical flexions and/or exercising the UCFs allow for a simple fitting and use of the apparatus such that the apparatus can be readily and easily used to perform and monitor cervical flexion without attendance by a trained professional.

[0009] Reference in this specification to a document is not to be taken as an admission that the disclosure therein constitutes common general knowledge in Australia.

OBJECT OF THE INVENTION

[0010] An object of this invention is to provide an apparatus and method for exercising the UCFs that obviates or reduces any one of the aforementioned difficulties, or at least provides the public with a useful choice.

SUMMARY OF THE INVENTION

[0011] For the purposes of this specification the word ‘comprising’ means ‘including but not limited to’, and the word ‘comprises’ has a corresponding meaning.

[0012] In one broad form of a first aspect of the invention, but not necessarily the broadest or only form, the invention could be said to reside in an apparatus for exercising and/or monitoring the performance of the upper cervical flexor muscles of the neck of a user, the apparatus including a resiliently compressible cushion dimensioned to fit beneath the mandible of the user but not extending a far as the chin, the mandible of a user bears against and compresses the cushion without the cushion engaging the chin, to thereby exercise the upper cervical flexor muscles whilst discouraging the exercising of other muscle, the cushion also including pressure measuring means for measuring changes in pressure within the cushion to monitor the performance of the upper cervical flexor muscles.

[0013] It will be appreciated that the mandible comprises the lower jaw line spanning from the rear of the chin and back to the neck, whereas the chin comprises only the foremost section of the jaw below the mouth.

[0014] The apparatus may be used to exercise the UCFs by providing resistance during head flexions and the performance of the exercise may be monitored by monitoring the pressure within the compressible cushion. Alternatively, or in addition, the apparatus may be used diagnostically to monitor the performance of the UCFs.

[0015] In one preferred form of the invention the compressible cushion includes one or more inflated or inflatable chambers such as an inflatable bladder. The inflated chamber may be a sealed air filled chamber. Alternatively the compressible cushion may include an inflatable chamber which may be connected to or be capable of connection to an inflation means for inflating and deflating the chamber. In this latter form the pressure within the chamber can be adjusted to thereby alter the degree of resistance to head flexion movement offered by the chamber.

[0016] Preferably the compressible cushion includes a foam layer underneath in which is positioned an inflated or inflatable chamber. The measuring means measuring pressure within the inflated or inflatable chamber. Thus the inflated or inflatable chamber may be inserted into a cellular foam collar which fits around the neck of the user.

[0017] The inflatable cushion may be formed from two opposed thermoplastic sheets sealed at their perimeter at least in part by heat welding, and including at least two side by side vertically extending spaced welds positioned within the perimeter to thereby limit the ballooning of the inflatable cushion. In one form the two welds are aligned vertically and in this form it is preferable to provide for a further weld laterally aligned to the at least two welds and spaced upwardly thereof to form together with the adjacent perimeter an upper chamber.

[0018] Preferably the cushion provides a snug fit under the mandible of the user so that the degree through which the head is rotated downward without resistance from the chamber is minimised. Positioning of the cushion underneath the mandible and rearward of the chin leads to the cushion being positioned as close as possible to the axis of rotation of the head during head flexions, which is just below the ears. This positioning may be effective in exercising the UCFs to the exclusion of other neck muscles. Similarly this, in the standing position, assists with having a plane of the face in an upright plane, for commencement of exercising, or monitoring.

[0019] The chamber may be part of a collar that can be positioned around the users neck, with the inflatable chamber positioned beneath the mandible. Preferably the inflatable chamber is positioned under the proximal part of the mandible, that is on the underside of the jaw and rearward of the chin. It may be preferred to have the top of the chamber that bears against the mandible substantially flat so as to provide a maximum surface area for engagement therewith.

[0020] The inflatable chamber may extend all of the way around the neck such as in an inflatable collar. In this way as the mandible is brought downward to bear against and compress the chamber, the air will be distributed toward the rear of the collar.

[0021] Alternatively, the inflatable chamber may be localised toward the front of the collar so that compressed air displaced when the user bends their head forward does not move to the rear of the apparatus. Thus the inflatable chamber may extend through an anterior portion of the collar only.

[0022] The cushion may be made an integral part of the collar however, alternatively the collar may be provided with a cushion fastening means located, in use, under the mandible, and the cushion having a corresponding fastening means, so that the cushion can be provided separately for fastening to the collar.

[0023] When in use the apparatus preferably allows for a monitoring of the flattening or straightening of the normal cervical lordosis. To this end, the apparatus may also include a separately inflatable rear chamber which is positioned adjacent the back of the neck and occupies the natural curvature of the neck when inflated. The rear chamber is preferably attached to a rear pressure monitoring means to monitor changes in pressure as the head flexion exercise is performed. Thus when the exercise is performed correctly an increase in pressure in the forward mandible chamber will be concomitant with an increase in pressure of the rear chamber as the curvature is flattened against it. It may be that change in contact pressure of the back of the neck against the rear chamber may be sufficient to give tactile feedback to the user so that the rear pressure monitor means is not required.

[0024] It will also be understood that another form of resilient compressible cushion may be used in place of the separately inflatable rear chamber. This may take any of the forms contemplated for the cushion to be located beneath the mandible.

[0025] It is preferred that the collar extends around the back of the neck and the rear cushion is positioned between the neck and the collar so that compression of the rear cushion occurs by reason of the rear of the neck bearing against the cushion which is held in place by the collar.

[0026] The inflation means preferably allows inflation of the chamber to a desired pressure, and also deflation of the chamber to allow for removal of air to assist with removal and storage of the apparatus. The desired pressure in the chamber will be somewhat dependent on the individual and can be determined by trial and error with each individual. In general it has been found that a pressure of between 10 and 30 mm Hg and more preferably about 15 to 25 mm Hg provides sufficient resistance to the downward movement of the head. Most preferably the pressure in the forward chamber is maintained at about 20 mm Hg.

[0027] The rear chamber may be inflated to a pressure of about 20 mm Hg, however this might be varied and an optimum can readily be ascertaining by simple trial and error.

[0028] In use, it has been found that cervicogenic headache sufferers are unable to hold a head flexion that increases pressure in the forward chamber by 10 mm Hg for 10 repetitions of 10 seconds or more. Therefore the apparatus may be used diagnostically to determine whether a particular patient has poor endurance of the UCFs by carrying out the above procedure. Those patients who are unable to maintain an increase of 10 mm Hg for 10 seconds and over 10 repetitions may be deemed to have poor endurance of the UCFs and may therefore be candidates for remedial treatment, which treatment may include exercising the UCFs using the apparatus of the present invention.

[0029] The apparatus may be used to monitor exercising of the UCF muscles. Thus, those persons identified by the above diagnostic tests may be set an exercise regime whereby they are required to perform head flexions that increase the pressure by 10 mm Hg and to hold that position for 10 seconds and repeat this 10 times in a day.

[0030] In a broad form of a second aspect of the invention, but not necessarily the broadest or only form, the invention could be said to reside in a method for exercising and/or monitoring the performance of the upper cervical flexor muscles of the neck, the method comprising the steps of:

[0031] positioning a resilient compressible cushion beneath the mandible of a user,

[0032] ensuring that the cushion does not bear against the chin,

[0033] the user bending their head forward on their neck to bear against and compress the cushion to thereby increase the pressure within the cushion,

[0034] and monitoring the performance of the exercise by monitoring the increase in pressure in the cushion.

[0035] Monitoring of the pressure in the cushion may be by way of a pressure measuring means which is capable of measuring the internal pressure within the cushion.

[0036] The method may also include the step of the user bending their head forward on the neck to thereby compress the cushion and increase the pressure in the cushion, and maintaining the increased pressure for a duration of time.

[0037] The compressible cushion may be in the form of an air filled chamber or bladder. The chamber may be deflatable and inflatable, in which case a suitable inflation means may be provided to inflate the chamber.

[0038] The desired increase in pressure in the chamber may be between 5 and 15 mm Hg and is most preferably about 10 mm Hg. That is the pressure increase is preferably 10 mm Hg above the pressure in the chamber in an uncompressed state. Preferably the duration of each compression is between 5 and 20 seconds, and is most preferably about 10 seconds.

[0039] The method may involve repeating the above exercise in cushions of a number repetitions.

[0040] The method may be used to determine whether users have poor endurance UCFs and therefore whether they are candidates for cervicogenic headaches, or whether poor endurance UCFs are a contributing factor to existing cervicogenic headaches. Thus those users that are unable to perform ten repetitions that increase the pressure by 10 mm Hg for 10 seconds may be selected as candidates having poor endurance UCFs.

[0041] The method may be used on those users with poor endurance UCFs to increase the endurance. Thus, the method may be practiced on a regular basis over an extended period of time in order to properly exercise and thereby increase the endurance the UCFs.

[0042] The method may also include the further step of positioning a separate rearward inflatable chamber adjacent the back of the neck so as to occupy the natural curvature of the lordosis when inflated. The rear chamber may also be attached to a pressure monitoring means to monitor changes in pressure as the exercise is performed. Thus when the exercise is performed correctly an increase in pressure in the forward mandible chamber will be concomitant with an increase in pressure of the rear chamber as the curvature is flattened against it.

BRIEF DESCRIPTION OF THE DRAWINGS

[0043] For a better understanding the invention will now be described with reference to an illustrated embodiment. The drawings describe an illustrated embodiment wherein,

[0044]FIG. 1 is a side view of a person wearing a collar having an inflatable front chamber positioned under the proximal part of the mandible,

[0045]FIG. 2 is the same as FIG. 1 but in which the head has undergone cervical flexion,

[0046]FIG. 3 is a front schematic view of one embodiment of the apparatus of the invention having a front inflatable chamber,

[0047]FIG. 4 is a schematic view from the top of FIG. 3 showing the relative dimensions of the front inflatable chamber,

[0048]FIG. 5 is a schematic plan view of the apparatus of FIG. 3,

[0049]FIG. 6 is a front schematic view of a second embodiment of the apparatus of the invention in which the inflatable chamber spans the length of the collar,

[0050]FIG. 7 is a schematic view from the top of FIG. 6 showing the relative dimensions of the inflatable chamber,

[0051]FIG. 8 is a schematic plan view of a third embodiment of the invention in which the apparatus has front and rear inflatable chambers,

[0052]FIG. 9 is a plan view of a fourth embodiment of the invention, showing the layout of welds to prevent ballooning,

[0053]FIG. 10 is a cross sectional view through X-X of FIG. 9,

[0054]FIG. 11 is a perspective view of a fifth embodiment of the envention whereby a small inflatable chamber is used for both a front and rear cushion, each being separately inflatable and each having a pressure guage to separately measure changes in pressure,

[0055]FIG. 12 is a partial plan view of the fifth embodiment fitted under the mandible of a user, the bladder shown uninflated, and also shown inflated in broken outline together with its influence of lifting an uppermost surface of the collar against the mandible of the user, and

[0056]FIG. 13 is a cross sectional view of the collar showing the rear inflatable cushion in relation to the back of the neck and the natural lordosis of the neck in its uninflated position and showing the extent of the inflated bladder in broken outline together with the effect of bearing the collar against the neck of the user.

DETAILED DESCRIPTION OF THE ILLUSTRATED EMBODIMENT

[0057] Similar reference characters indicate corresponding parts throughout the several views of the drawings.

[0058] Dimensions of certain of the parts shown in the drawings may have been modified and/or exaggerated for the purposes of clarity or illustration.

[0059] The illustrations show an apparatus (1) for exercising the upper cervical flexor (UCF) muscles of the neck. In use the apparatus is positioned beneath the mandible of the user as best seen in FIGS. 1 and 2 and the upper cervical flexor muscles are exercised by the user performing head flexions by bending their head forward on their neck to bear against the resilient compressible cushion (2). Positioning of the cushion underneath the mandible and rearward of the chin means that the cushion is positioned as close as possible to the axis of rotation of the head during head flexions, which is just below the ears. This position is found to be most effective in exercising the UCFs to the exclusion of other neck muscles. Performance of the exercise is indicated by a change in internal pressure within the cushion.

[0060] In the apparatus illustrated in FIGS. 3 to 13, the resilient compressible cushion is in the form of an inflatable chamber. However it will be appreciated that the invention is not restricted thereto and the resilient compressible cushion may be made of any suitable material that is compressible and regains its shape after removal of the compression. Suitable materials may therefore include sponge like material. However the internal pressure within the cushion must be able to be measured in order to monitor the head flexions. In the case of a foamed material, the cushion may be surrounded by an air tight bladder which is in fluid connection with a pressure measuring means to measure changes in internal pressure within the bladder. Alternatively, a pressure transducer may be positioned within the cushion so that transducer measures compression of the sponge like material as it is compressed.

[0061] Turning to FIGS. 3 to 8, the apparatus comprises an inflatable chamber (2) for positioning beneath the mandible (3) of a user. The chamber includes inflation means (4) in the form of an air pump having a compressible bulb (5) for inflating the chamber (2) with air. The pump also includes a relief valve (6) which comprises a thumb screw (7) mounted in a collar (8) fixed to tubing (9) which runs from the pump to an inlet (10) in the chamber. When the thumb screw (7) is rotated into the collar (8) no air can escape from the pump or chamber, whilst when the thumbscrew (7) is rotated outwardly from the collar (8) the valve is opened to allow air to escape to thereby deflate the chamber. Whilst one particular form of inflation means is illustrated it will be understood that the inflation means may be any suitable means for allowing inflation of the chamber.

[0062] Pressure measuring means (11) in the form of a mechanical pressure gauge is attached by way of T-junction to the tubing (9). The gauge (11) provides a means for visually monitoring changes in pressure within the chamber (2). The gauge may be any suitable digital or rotary-type pressure gauge.

[0063] The chamber (2) is in the form of an air tight bladder. The chamber may be constructed from any suitable polymeric material, including plastics such as polyethylene, or an elastomer such as rubber and/or similar natural or synthetic materials such as latex. In a preferred embodiment of the invention the chamber is formed from sheets of material having limited elastomeric properties such as a soft vinyl that are welded into a box like construction using standard plastics welding techniques. This type of material has been found to be beneficial in constructing the chamber because the material is relatively inflexible compared to a latex type material, and the relative inflexibility assists in generally maintaining the shape of the cushions and in providing resistance to the flexion movement of the head.

[0064] In an embodiment of the invention that is illustrated in FIGS. 6 and 7, the chamber is in the form of a collar that is shaped to fit around the neck of the user. The chamber has an inlet (10) which is in fluid communication with the air pump (4) and pressure gauge (11) by way of tubing (9). The tubing is fabricated from suitable plastics, rubber or similar natural or synthetic materials.

[0065] The collar does not have a constant width all of the way around but instead is wider at the front than at the back. In this way when the collar is fitted, the bladder is tapered so as to narrow toward the back of the neck of the user. This allows for less of an increase in pressure toward the back of the collar when the front part of the collar is compressed during head flexions. In this way the collar does not prevent or lessen the likelihood of straightening of the normal cervical lordosis which is necessary for correct head flexions and hence correct exercise of the UCFs.

[0066] The overall width of the collar, particularly at the front, can be varied to suit individuals with different neck height. Thus, for instance the collar may be produced in widths of 8 cm, 9 cm or 10 cm but may be varied to provide for more effective starting position for exercising or monitoring. Generally it is desired that the starting position is where the plane of the face is upright, which will be assumed where the head is held upright and forward facing.

[0067] The bladder (2) is wrapped in an external covering (12) to form a wearable collar for the comfort of the user. Respective ends (13) and (14) of the collar contain fastening means in the form of hook and loop fastener such as sold under the trade mark VELCRO™. In this way the collar can be placed around the users neck and the ends fastened using the hook and loop fasteners. The diameter of the collar can be adjusted to suit patients having different neck dimensions.

[0068] The top of the bladder is substantially flat but is also shaped to conform to the shape of the mandible of the user and therefore provide a comfortable fit as well as bearing firmly against the mandible to minimise the degree through which the head can be moved downward freely without resistance from the bladder. Thus the upper section of the collar contains a cut away section (or concavity) (15) that is curved so as to fit snugly against the underside of the users chin, with increased width sections (16) and (17) positioned adjacent the cheekbones. The underside of the bladder then bears against the chest of the user.

[0069] In the illustrated embodiment the width of the collar at the cut away section (15) is 9 cm, whilst it is 6 cm at respective ends (13) and (14). The overall length of the collar is 272 cm.

[0070] An alternative form of the invention is illustrated in FIGS. 3 to 5 wherein the chamber (2) does not extend all of the way around the neck but is restricted to the anterior portion of the user under the mandible. This form may be beneficial because when the chamber is compressed there is no redistribution of compressed air toward the rear of the apparatus which may tend to prevent or lessen the likelihood of flattening of the normal lordosis that is necessary for proper exercise of the UCFs. Further, the lower volume of the chamber also provides a more rapid increase in pressure as the chamber is compressed during flexions. In this form the chamber may be affixed to a standard material (18) to thereby form a collar which may be fitted in the usual way such as by way of hook and loop fastener at the respective ends (13) and (14). The chamber extends 240 cm along the length of the collar, which has an overall length of 272 cm. The depth of the chamber is 2.8 cm and it is 9 cm wide adjacent the cut away section (15). The width of the chamber may also be varied to suit individuals with different neck heights. Thus the width of the chamber may vary between 6 cm and 12 cm. Alternatively the width of the chamber may be varied by constructing the chamber from a plurality of smaller chamber that may be joined together to give a chamber with a desired width.

[0071] Another alternative embodiment is illustrated in FIG. 8, wherein in addition to the localised anterior chamber, the apparatus contains a separate posterior chamber (19) that is shaped to assist in maintaining the natural lordosis of the neck when the correct head flexion exercise is performed. The posterior bladder may be separately inflatable and therefore may contain a separate inflation (4′) and pressure measuring means (11′) in the same way as the anterior chamber. The anterior face of the posterior chamber is curved so that when the chamber is inflated it occupies the natural curvature of the lordosis.

[0072] A fourth embodiment is shown in FIGS. 9, and 10, in which is illustrated a cushion for positioning under the mandible in the manner described above for the first three illustrated embodiments. This cushion is constructed from two opposed sheets of thermoplastics material such as the soft vinyl referred to above, which sheets are sealed at their perimeter (20). This may be achieved by folding one sheet over and welding three of the sides or by welding all of the sides. These perimeter welds are not shown in the illustrations. A cut away section forms a concavity (21) in an upper side of the cushion, to provide means of positively positioning the cushion under the mandible, and furthermore provides for a close positioning under the chin. A convexity (22) is provided on the opposed lower side and this rests on the upper chest of the user. There are provided four vertically extending welds (23, 24, 25, 26) positioned internally of the perimeter and spaced apart from each other. These vertically extending welds have the effect of limiting the extent to which the opposed thermoplastics sheets can be separated and thus dictate the shape of the cushion in the inflated form. These vertically aligned welds prevent ballooning of the cushion, and furthermore assist with a controlled curving of the collar around the front of the neck. This embodiment when used takes up a position similar to the embodiment shown in FIG. 5. It will be seen that the uprights are spaced sufficiently to allow for a substantial vertical column of air to be present therebetween to provide for adequate resistance to pressure from the mandible on commencement of exercising. More or less of these vertical welds may be provided to give the desired balance between comfort for the user and resistance to mandible pressure. It will be seen that the vertical welds do not extend all the way from the lower side to the upper side of the cushion, and allow for an amount of ballooning at either end. This provides for the capacity to inflate and deflate the cushion from one valve, and also provides for generally horizontal upper cushion chamber (29) and lower cushion chamber (30), for comfort of fit for the user, and an even surface across the upper side and lower side for engagement against the mandible and upper chest of the user. There are also provided two further welds (27, 28) extending laterally to the vertically extending welds. These provide a divide for the upper cushion chamber and lower cushion chamber respectively, and provide stability against tearing of vertically extending welds. This embodiment is provided with a connector (31) to which can be connected means for measuring the pressure within the cushion, and means to inflate the cushion.

[0073] The cushion of this embodiment is provided separately from a collar, and is provided with suitable fastener to fasten it in place on a collar. The collar will be put into position and the cushion is to be fastened on the outside of the collar. Hook and loop material (32) is provided on one sheet of the cushion as can be seen in FIG. 10, and this can be used as means of fastening to the collar. Means might be provided to register the cushion on the collar before fastening so that accurate placement is achieved for every fitting. Alternatively the concavity (21) might be relied upon to position the cushion.

[0074] It will be seen that this embodiment whilst divided into cushion parts is still inflatable from one valve. It might be desired however to isolate perhaps one or more of the cushion parts for separate measurement of the change in pressure on commencement of the exercise. Thus the upper cushion chamber (29) could be totally isolated from the remainder of the cushion by welding and a separate valve could be connected with the upper cushion chamber for separate measurement and inflation. The reduced volume of air might be desired for changed sensitivity of measurement, or as a means of restricting the degree of head movement, vertically that could be measured, where for example the remainder of the collar is relatively less compressible.

[0075] It might also be desired for this fourth embodiment to provide a rear cushion also separately fastenable by similar means. It is envisaged that the rear cushion would not have internal welds and it would be fastened to the inside of the collar.

[0076] A fifth embodiment is shown in FIGS. 11 to 13. In this embodiment a foam collar (40) is provided. The foam collar is covered by a material sleeve to provide tactile comfort for the user. The foam collar is inserted into open ends of the sleeve which are then fastened closed. Fasteners (42, 43) are provided at both ends in the form of hook and loop fasteners such as sold under the trade mark VELCRO® so that the collar can be fastened to the neck of a user. The cushion is made of a thickness that fits under the mandible only of the user, and include a concavity (44) that accommodates the mandible, an extension or convexity (44 a) beneath the concavity which extends the collar so as to contact the upper chest of the user, and the remainder of the collar is suitably shaped to sit comfortably over the shoulders, so that there are no distortions on the sponge material whilst in place other than by reason of head movement. The collar is approximately 3 cm wide. This width is such that the collar sits comfortably around the neck the foam material being easily curved without exerting undue pressure on the neck, and also sitting well inside of the chin of the user.

[0077] It can be seen that the collar is fastened at the side of the neck. A thin flat inflatable front bladder (45) is inserted into the sponge material. The front bladder is made from an elastomeric material and has dimensions of approximately 9 cm by 2.8 cm wide so that it fits well within the foam construction of the collar, and extends along the collar for a length that need not extend beyond the mandible of the user. Indeed it might be made somewhat shorter and exert a lifting effect on only a part of the foam central to the mandible of the user. In the uninflated state the bladder is in the order of 3 mm high and in an inflated form it can distend to about 2.5 cm in height as shown in broken outline (46) in FIG. 12. The effect of this distension is that when the collar is fitted the concavity of the collar need not necessarily fit tightly against the mandible of the user, because the front bladder when inflated will raise part of the top surface (47) of the collar to bear against the mandible of the user, as more particularly shown in FIG. 12. The bladder may be moulded in place during formation of the sponge to make up the collar, the bladder includes a tube extending out from the sponge material to form a connector to which suitable pressure measuring apparatus and/or an inflation pump may be attached. FIG. 11 shows a pump and pressure measuring apparatus, substantially as described for earlier illustrated embodiments. The inflatable bladder is positioned such that the upper surface of the collar is raised in a direction bearing against the mandible of the user.

[0078] This fifth embodiment also includes a second bladder (50) to bear against the rear of the neck to encourage correct posturing of the rear of the neck in relation to cervical lordosis during exercising or monitoring. The second bladder is similar in shape and size to the bladder (45) except that flat inflatable bladder is positioned such that it bears against the back of the neck, inflation therefore does not bear upwardly but rather across the width of the collar and thereby exerts a pressure against the back of the neck as shown in FIG. 13. A separate inflation and pressure measuring means might be provided as shown in FIG. 11, or alternatively a connector tube might provide communication between the two bladders so that on inflation of the front bladder the second bladder is also inflated. Alternatively a single inflation means might be provided to inflate both bladders but separate pressure measuring means might be provided to measure a change in pressure in a respective bladder separately. Similarly it might be desired to provide an insert of fixed size into the collar at that position to provide a constant protrusion. Such an insert might be made of a denser foam than the collar is made of, or alternatively the collar could be moulded to provide for a protrusion that extends into the back of the neck.

[0079] In use, the user performs suitable head flexions by performing a nodding action, which action causes the chin to be tucked in and this is met by resistance of the inflated front chamber (see FIG. 2). The initial head position is such that the plane of the face is upright. This initial head position assists with exercising the UCFs over a desired movement range to the exclusion of other muscle groups. The pressure in the chamber can be adjusted in order to alter the amount of resistance against the flexion movement. In practice it is found that a pressure of 20 mm Hg is suitable for most patients and provides suitable resistance. As the flexion movement is carried out and the proximal mandible bears against and compresses the chamber, the pressure rises in the chamber and this increase in pressure can be monitored using the gauge (11). In practice it has been found that persons suffering from poor endurance of the UCF muscles are unable to maintain an increase in pressure of 10 mm Hg (ie. to 30 mm Hg) for 10 seconds over 10 repetitions. This figure can therefore be used as a guide diagnostically and a patient that cannot perform the exercise will be a candidate for remedial work to increase the endurance of the UCFs. The apparatus can then be used as a remedial exerciser for the UCFs in that the user can perform suitable head flexions by following an exercise regime of performing 10 or more repetitions of holding a 10 mm Hg increase in pressure of 10 seconds.

[0080] The ease of use of the apparatus means that the user can perform the suitable exercises in the privacy of their own home and also in their own time and without the supervision of a practitioner. The relative simplicity of the apparatus also means that it may be relatively inexpensive to manufacture and therefore provides an affordable apparatus and method for monitoring the exercising the UCFs. 

1. An appartus for exercising and/or monitoring the performance of the upper cervical flexor muscles of the neck of a user, the apparatus including a resiliently compressible cushion dimensioned to fit beneath the mandible of the user but not extending a far as the chin, the mandible of a user bears against and compresses the cushion without the cushion engaging the chin, to thereby exercise the upper cervical flexor muscles whilst discouraging the exercising of other muscle, the cushion also including pressure measuring means for measuring changes in pressure within the cushion to monitor the performance of the upper cervical flexor muscles.
 2. An apparatus for exercising and/or monitoring the performance of the upper cervical flexor muscles of the neck of a user as in claim 1 wherein the compressible cushion includes one or more inflated chambers.
 3. An apparatus for exercising and/or monitoring the performance of the upper cervical flexor muscles of the neck of a user as in claim 2 wherein the inflated chamber is a sealed air filled chamber.
 4. An apparatus for exercising and/or monitoring the performance of the upper cervical flexor muscles of the neck of a user as in claim 2 wherein the compressible cushion includes an inflatable chamber connected to or being capable of connection to an inflation means for inflating and deflating the chamber.
 5. An apparatus for exercising and/or monitoring the performance of the upper cervical flexor muscles of the neck of a user as in either one of claims 2 or 4 wherein the compressible cushion includes a foam layer underneath which is positioned the inflated or inflatable chamber.
 6. An apparatus for exercising and/or monitoring the performance of the upper cervical flexor muscles of the neck of a user as in claim 5 being a foam collar wherein the inflated or inflatable chamber is inserted therein and said collar which fits around the neck of the user.
 7. An apparatus for exercising and/or monitoring the performance of the upper cervical flexor muscles of the neck of a user as in claim 4 wherein the inflatable cushion may be formed from two opposed thermoplastic sheets sealed at their perimeter at least in part by heat welding, one of said thermoplastic sheets aligned to be positioned adjacent to the neck of the user and said inflatable cushion including at least two side by side vertically extending spaced welds positioned within the perimeter to thereby limit the ballooning of the inflatable cushion.
 8. An apparatus for exercising and/or monitoring the performance of the upper cervical flexor muscles of the neck of a user as in claim 7 wherein there is provided a further weld laterally aligned to the at least two welds and spaced upwardly thereof to form together with the adjacent perimeter an upper chamber for positioning directly under the mandible of the user.
 9. An apparatus for exercising and/or monitoring the performance of the upper cervical flexor muscles of the neck of a user as in claim 4 wherein the chamber is part of a collar that can be positioned around the users neck, with the inflatable chamber positioned beneath the mandible.
 10. An apparatus for exercising and/or monitoring the performance of the upper cervical flexor muscles of the neck of a user as in claim 9 wherein the inflatable chamber extend all of the way around the neck to form a wholy inflatable collar.
 11. An apparatus for exercising and/or monitoring the performance of the upper cervical flexor muscles of the neck of a user as in claim 9 wherein the inflatable chamber extends through an anterior portion of the collar only.
 12. An apparatus for exercising and/or monitoring the performance of the upper cervical flexor muscles of the neck of a user as in claim 9 wherein the cushion is an integral part of the collar.
 13. An apparatus for exercising and/or monitoring the performance of the upper cervical flexor muscles of the neck of a user as in claim 9 wherein the collar is provided with a cushion fastening means located, in use, under the mandible, and the cushion having a corresponding fastening means, so that the cushion is separately fastened to the collar.
 14. An apparatus for exercising and/or monitoring the performance of the upper cervical flexor muscles of the neck of a user as in claim 1 also including a separate rear cushion which is positioned adjacent the back of the neck to exert pressure thereto during use.
 15. An apparatus for exercising and/or monitoring the performance of the upper cervical flexor muscles of the neck of a user as in claim 14 wherein the rear cushion is attached to a rear pressure monitoring means to monitor changes in pressure in the rear cushion as the head flexion exercise is performed.
 16. An apparatus for exercising and/or monitoring the performance of the upper cervical flexor muscles of the neck of a user as in claim 14 wherein the apparatus includes a collar that extends around the back of the neck and the rear cushion is positioned between the neck and the collar so that compression of the rear cushion occurs by reason of the rear of the neck bearing against the cushion which is held in place by the collar.
 17. A method for exercising and/or monitoring the performance of the upper cervical flexor muscles of the neck, the method comprising the steps of: positioning a resilient compressible cushion beneath the mandible of a user, ensuring that the cushion does not bear against the chin, the user bending their head forward on their neck to bear against and compress the cushion to thereby increase the pressure within the cushion, and monitoring the performance of the exercise by monitoring the increase in pressure in the cushion.
 18. A method for exercising and/or monitoring the performance of the upper cervical flexor muscles of the neck as in claim 17 including maintaining the increase in pressure for a duration of time.
 19. A method for exercising and/or monitoring the performance of the upper cervical flexor muscles of the neck as in claim 17 said pressure increased by about 10 mm Hg.
 20. A method for exercising and/or monitoring the performance of the upper cervical flexor muscles of the neck as in claim 17 wherein the method is used to monitor the performance of the user.
 21. A method for exercising and/or monitoring the performance of the upper cervical flexor muscles of the neck as in claim 20, whereby the performance of a user is diagnosed by the capacity to hold a head flexion that increases pressure in the cushion by about 10 mm Hg for 10 repetitions of 10 seconds or more
 22. A method for exercising and/or monitoring the performance of the upper cervical flexor muscles of the neck as in claim 17, whereby the user exercises by performing one or more head flexions that increase pressure in the cushion by 5 and 15 mm Hg for about 10 seconds.
 23. A method for exercising and/or monitoring the performance of the upper cervical flexor muscles of the neck as in claim 22, whereby the user exercises by performing one or more head flexions that increase pressure in the cushion by about 10 mm Hg for about 10 seconds.
 24. A method for exercising and/or monitoring the performance of the upper cervical flexor muscles of the neck as in claim 17, whereby the user exercised by performing one or more head flexions that increase pressure in cushion by about 10 mm Hg for 10 repetitions per day of 10 seconds.
 25. A method for exercising and/or monitoring the performance of the upper cervical flexor muscles of the neck as in claim 17, whereby additionally a rear pressure is applied to the back of the neck so as to provide feedback to the user that a flattening of lordosis occurs when the users head is bent forwards.
 26. A method for exercising and/or monitoring the performance of the upper cervical flexor muscles of the neck as in claim 17 wherein the method includes monitoring for an increase in pressure at the back of the neck.
 27. A method for exercising and/or monitoring the performance of the upper cervical flexor muscles of the neck as in claim 17 wherein the cushion is fitted snugly under the mandible of the user.
 28. A method for exercising and/or monitoring the performance of the upper cervical flexor muscles of the neck as in claim 29 wherein the cushion is fitted such that, in the upright position a plane of the face is upright, for commencement of exercising, or monitoring. 